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Medicare 101: Understanding the Basics of Medicare

It’s important to plan ahead and prepare for Medicare. The first step is understanding your options. Our Medicare guide will help you understand your options, including how to stay connected with your current doctor if that’s what you choose.

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What are the basics of Medicare?

Before you enroll in a plan, let’s examine some Medicare basics by answering a few common questions:

  • What is Medicare?

    Medicare is a federal health insurance program for people 65 and older as well as people younger than 65 who have a qualifying disability. Medicare is different from Medicaid, which offers health insurance and other services to eligible low-income people of all ages.

  • Is Medicare the same as Medicaid?

    Medicare and Medicaid are different in that Medicare is reserved for eligible individuals who are typically 65 and older, although some can qualify before age 65 if they have certain conditions. On the other hand, Medicaid offers health care coverage and other services to eligible low-income people.

  • With Medicare, can I see my doctor?

    In many cases, yes. If you enroll in Original Medicare, you can visit any doctor that accepts Medicare. If you enroll in a Medicare Advantage plan, you must ensure the plan you select contracts with your preferred provider.

  • What does Medicare cost each month?

    With Original Medicare, most people do not pay a premium for Part A. In 2022, the Medicare Part B monthly premium is $170.10. Premiums for Medigap coverage, Part C, and Part D vary by plan.

  • When should I enroll in Medicare?

    You can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

What are the 4 parts of Medicare?

Medicare has four distinct parts, with each one covering different benefits. You can combine certain parts in order to meet your health care needs.

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Part A: Hospital Insurance

Medicare Part A is offered to those who paid Medicare taxes while working. For most, it is not necessary to pay a monthly premium for the coverage.

  • Inpatient Hospital Care
  • Skilled Nursing Care
  • Hospice Care
  • Home Health Care
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Part B: Medical Insurance

Part B covers 80% of all medical costs not covered by Part A. However, unlike Part A, you need to elect Part B when you turn 65. Part A and B together make up Original Medicare.

  • Doctor Visits
  • Lab Tests
  • Medical Equipment
  • Preventative Services
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Part C: Medicare Advantage

Medicare Advantage plans are offered by private insurers and approved by Medicare. They often provide extra benefits and access to Part D coverage.

  • Includes Parts A and B
  • Usually includes Part D
  • May include Dental and Vision
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Part D: Prescription Coverage

Part D offers prescription drug plans from private companies approved by Medicare. Prescription drug coverage is recommended, as beneficiaries who do not sign up for Part D will incur a lifetime late enrollment penalty.

  • Prescription Drugs

How do I enroll in Original Medicare? 

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). For an additional cost, you can purchase Medicare Supplement Insurance (Medigap) and Part D (Prescription Drug Coverage) to help cover what Original Medicare does not.

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    Enroll automatically

    You are automatically enrolled in Original Medicare if you already receive Social Security or Railroad Retirement Board benefits.

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    Enroll yourself

    If you do not qualify for automatic enrollment, you must enroll yourself by contacting the Social Security Administration.

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New to Medicare?
View our educational seminar.

In this free virtual event, you’ll learn about the different parts of Medicare and how they work together to provide your health care coverage. You’ll also learn what your options are and when you need to enroll to ensure uninterrupted care. 

More About Original Medicare

Once you are enrolled in Part A and Part B, it’s time to make sure you have the best coverage for you. Here are a few common questions about Original Medicare.

  • Is Original Medicare free?

    No. In addition to your monthly premiums for Part B, you are responsible for deductibles, copayments, and coinsurance.

  • Are prescription drugs covered?

    No. If you want prescription drug coverage, you’ll need to purchase a separate Part D plan or enroll in a Medicare Advantage plan.

  • Are dental, vision, or hearing covered?

    No, routine services are not typically covered under Original Medicare. However, you may add a Medigap plan to supplement your Original Medicare coverage or enroll in a Medicare Advantage plan, both can provide additional coverage for these services.

  • What is a Medigap plan?

    Medigap plans, also known as Medicare Supplement Insurance, help pay for health care costs Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

How to Enroll in Medicare Advantage

Medicare Advantage, or Part C, is a separate pathway to receiving your Medicare benefits. These plans include Part A (Hospital Insurance) and Part B (Medical Insurance) and usually include Part D (Prescription Drug Coverage). They may also include dental, vision, and other benefits.

  1. Enroll in Part A and Part B

    You must enroll for Part A and Part B before you can enroll in a Medicare Advantage plan.

  2. Compare plans in your area

    Advise can help you find a plan in your area that meets your health care needs and contracts with your preferred providers.

More About Medicare Advantage

Different Medicare Advantage plans offer different benefits. Here are a few common questions about Medicare Advantage.

  • Is Medicare Advantage free?

    No. In addition to your monthly premiums for Part B, you pay a separate premium for a Medicare Advantage plan. Many Medicare Advantage plans offer a low or no-cost premium.

  • Are dental, vision, or hearing covered?

    Many Medicare Advantage plans cover dental, vision, and hearing services. They may also offer additional benefits like wellness programs or transportation to or from medical appointments.

  • Are prescription drugs covered?

    Yes, most Medicare Advantage plans include prescription drug coverage.

  • Medicare Advantage vs Medigap?

    Medicare Advantage is an alternative to Original Medicare, while Medigap supplements your Original Medicare coverage. Medigap policies can’t work with Medicare Advantage plans.

Understanding the costs

Medicare doesn’t cover everything, and there are often additional costs associated with your coverage. Making sure you understand your coverage before you enroll can help you save money and better understand what you’re paying for.

In addition to your monthly Part B premium, the three costs you might have are:

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Deductible

The amount you pay out of pocket for covered services before Medicare begins to cover its share.

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Coinsurance

The percent of the Medicare-approved costs you are responsible for after you met your deductible.

Copay

The set amount you pay for a medical service, such as a doctor’s visit, at the time of care.

There is no limit to Original Medicare costs. You are responsible for coinsurance and copayment costs regardless of how high they may go. Medicare Advantage plans, however, protect you with an annual maximum out-of-pocket limit.

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Book your Medicare Consultation

Let our Advise Medicare experts help you navigate the Medicare maze.  Fill out the form information to begin the conversation. 

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    Get personalized answers to your Medicare questions

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    Review your Medicare goals

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    Discuss options that meet your unique needs

Please fill out the form below, and we will get back to you as soon as possible. You can also call us directly at (855) 699-4240 (TTY: 711).

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